HomeMy WebLinkAboutMortgage_Elpers (22)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-' � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
`«. � Sfate Fam 43709 (R4 / 16-01 J F---� �
PresmbeC by Department of Local Govemment Finance �
INSTRUCTIONS: O E C 2 7���a�
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months be/ore May 11 of the year the deduction is�to be effective. �� �//�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Marcb 31 �the year� d" ction-l5`Ca�Oe eHective.
See reverse side (or additional instructions and qualifications. �iBS No ��,tiH? v AUDITOR �
Ap ' nt (owneror ntract er- see restrictions reverse side)
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Taxi istrid Key numb / legal description Record number
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D�/ _ � / � _ Page number
Asse s d value of real property as of Mortgage ! Contract indebtedness unpaid as of Is the applipnt the sole legal or equitable
Mar , wrrent year March 1, currenl year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hmie (IC 61.1-�
me of mortgagee or conVad s�e('l�ler
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Address of mortgagee or contrad selier (n ber and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sUeet, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Taxing District? Has lhis dedudion been requested on
county in Indiana? property for wrrent yeaR � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County AudRor Date
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
a resident of Indiana and owner of ihe aforementioned property on March 1, 20
Si ure (owners (ull name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
esi ent address o a plicanl Address of authorized person
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